{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:25:22Z","timestamp":1787772322171,"version":"build-2784847793"},"reference-count":38,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:p>Chylothorax and chyloperitoneum are rare in infants and challenging to definitively diagnose by using current criteria extrapolated from the adult population. They can be of primary or secondary etiologies, including congenital lymphatic malformations and postoperatively, after cardiothoracic or abdominal surgery. Current first-line management consists of bowel rest, parenteral nutrition, and a modified diet of medium-chain triglycerides but can often take weeks to be effective. Off-label use of octreotide has been reported in numerous case studies for the management of chylous effusions. However, there are no definitive neonatal data available regarding dosing, safety, and efficacy; moreover, octreotide has a side effect profile that been linked to serious morbidities, such as pulmonary hypertension and necrotizing enterocolitis. Propranolol, commonly used for the treatment of infantile hemangiomas, is currently gaining interest as a novel therapy for chylous effusions. In this case series review, we describe the use of propranolol in 4 infants with presumed chylous effusions: 1 with congenital pleural effusions and 3 infants who developed postoperative chylothorax and\/or chylous ascites. Clinical improvement was noted within a few days of initiating oral propranolol, and the maximum dose used in our cases was 6 mg\/kg per day. In previous case reports, researchers describe the use of oral propranolol in infants with chylous effusions, with the dose used ranging from 0.5 to 4 mg\/kg per day. However, this is the first case series in which researchers report its use exclusively in infants with chylothorax and chyloperitoneum. Although further research is needed to establish safety and efficacy, our experiences suggest that propranolol could be an acceptable treatment option for chylous effusions in infants.<\/jats:p>","DOI":"10.1542\/peds.2020-049699","type":"journal-article","created":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T08:25:16Z","timestamp":1624955116000},"source":"Crossref","is-referenced-by-count":23,"title":["Use of Propranolol in the Treatment of Chylous Effusions in Infants"],"prefix":"10.1542","volume":"148","author":[{"given":"Kaitlin","family":"Mitchell","sequence":"first","affiliation":[{"name":"Sunrise Children\u2019s Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Weiner","sequence":"additional","affiliation":[{"name":"Sunrise Children\u2019s Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada"},{"name":"Department of Pediatrics, University of Nevada, Las Vegas, Nevada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Ramsay","sequence":"additional","affiliation":[{"name":"Sunrise Children\u2019s Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada"},{"name":"Department of Pediatrics, University of Nevada, Las Vegas, Nevada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitali","family":"Sahni","sequence":"additional","affiliation":[{"name":"Sunrise Children\u2019s Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada"},{"name":"Department of Pediatrics, University of Nevada, Las Vegas, Nevada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2021,7,1]]},"reference":[{"issue":"3","key":"2021121007542412000_B1","first-page":"91","article-title":"Congenital fetal and neonatal visceral chylous effusions: neonatal chylothorax and chylous ascites revisited. A multicenter retrospective study","volume":"45","author":"Bellini","year":"2012","journal-title":"Lymphology"},{"issue":"3","key":"2021121007542412000_B2","doi-asserted-by":"crossref","first-page":"358","DOI":"10.7326\/0003-4819-96-3-358","article-title":"Evaluation and management of chylous ascites","volume":"96","author":"Press","year":"1982","journal-title":"Ann Intern Med"},{"issue":"4","key":"2021121007542412000_B3","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1542\/peds.2013-2072","article-title":"Chylothorax in infants and children","volume":"133","author":"Tutor","year":"2014","journal-title":"Pediatrics"},{"issue":"2","key":"2021121007542412000_B4","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/ANC.0000000000000257","article-title":"Congenital chylothorax: a unique presentation of nonimmune hydrops fetalis in a preterm infant","volume":"16","author":"Brock","year":"2016","journal-title":"Adv Neonatal Care"},{"issue":"3","key":"2021121007542412000_B5","first-page":"58","article-title":"Congenital chylous ascites","volume":"76","author":"Roma\u0144ska-Kita","year":"2011","journal-title":"Pol J Radiol"},{"issue":"2","key":"2021121007542412000_B6","first-page":"175","article-title":"Diagnosis and management of congenital neonatal chylous ascites","volume":"16","author":"Mouravas","year":"2012","journal-title":"Hippokratia"},{"issue":"6","key":"2021121007542412000_B7","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1016\/j.jtcvs.2017.08.002","article-title":"Diaphragmatic fenestration for refractory chylothorax after congenital cardiac surgery in infants","volume":"154","author":"Kumar","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"11","key":"2021121007542412000_B8","first-page":"700","article-title":"The lipoprotein profile of chylous and nonchylous pleural effusions","volume":"55","author":"Staats","year":"1980","journal-title":"Mayo Clin Proc"},{"issue":"5","key":"2021121007542412000_B9","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1067\/mpd.2000.104287","article-title":"Etiology and management of pediatric chylothorax","volume":"136","author":"Beghetti","year":"2000","journal-title":"J Pediatr"},{"issue":"3","key":"2021121007542412000_B10","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1378\/chest.116.3.682","article-title":"Chylothorax in children: guidelines for diagnosis and management","volume":"116","author":"B\u00fcttiker","year":"1999","journal-title":"Chest"},{"issue":"7","key":"2021121007542412000_B11","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1038\/sj.jp.7210975","article-title":"Treatment of chylothorax in a premature infant using somatostatin","volume":"23","author":"Goto","year":"2003","journal-title":"J Perinatol"},{"issue":"5","key":"2021121007542412000_B12","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1067\/msy.2000.109502","article-title":"Chylous ascites: a collective review","volume":"128","author":"Aalami","year":"2000","journal-title":"Surgery"},{"key":"2021121007542412000_B13","first-page":"3903598","article-title":"Neonatal chylothoraces: a 10-year experience in a tertiary neonatal referral centre","volume":"2019","author":"White","year":"2019","journal-title":"Case Rep Pediatr"},{"key":"2021121007542412000_B14","doi-asserted-by":"crossref","first-page":"bcr2012006196","DOI":"10.1136\/bcr-2012-006196","article-title":"Successful management of congenital chylous ascites with early octreotide and total parenteral nutrition in a newborn","volume":"2012","author":"Olivieri","year":"2012","journal-title":"BMJ Case Rep"},{"issue":"12","key":"2021121007542412000_B15","doi-asserted-by":"crossref","first-page":"e3109","DOI":"10.1097\/MD.0000000000003109","article-title":"Anatomic and functional evaluation of central lymphatics with noninvasive magnetic resonance lymphangiography","volume":"95","author":"Kim","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"4","key":"2021121007542412000_B16","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1053\/j.tvir.2016.10.002","article-title":"Novel lymphatic imaging techniques","volume":"19","author":"Dori","year":"2016","journal-title":"Tech Vasc Interv Radiol"},{"issue":"4","key":"2021121007542412000_B17","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.2214\/ajr.171.4.9763006","article-title":"MR lymphangiography in infants, children, and young adults","volume":"171","author":"Laor","year":"1998","journal-title":"AJR Am J Roentgenol"},{"issue":"1","key":"2021121007542412000_B18","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/S0022-3468(85)80397-3","article-title":"The management of chylous ascites in children","volume":"20","author":"Man","year":"1985","journal-title":"J Pediatr Surg"},{"issue":"5\u20136","key":"2021121007542412000_B19","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/BF00497824","article-title":"Successful treatment of congenital chylous ascites with a somatostatin analogue","volume":"11","author":"Caty","year":"1996","journal-title":"Pediatr Surg Int"},{"issue":"3","key":"2021121007542412000_B20","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s40268-018-0237-9","article-title":"Octreotide use in neonates: a case series","volume":"18","author":"Zaki","year":"2018","journal-title":"Drugs R D"},{"issue":"2","key":"2021121007542412000_B21","first-page":"e33","article-title":"Use of octreotide in the treatment of chylothorax and chyloperitoneum","volume":"97","author":"Pessotti","year":"2011","journal-title":"Arq Bras Cardiol"},{"issue":"2","key":"2021121007542412000_B22","doi-asserted-by":"crossref","first-page":"91","DOI":"10.4103\/2249-4847.96767","article-title":"Use of octeriotide in the management of neonatal chylothorax secondary to repair of congenital diaphragmatic hernia: a report of two cases and review of literature","volume":"1","author":"Jarir","year":"2012","journal-title":"J Clin Neonatol"},{"key":"2021121007542412000_B23","doi-asserted-by":"crossref","DOI":"10.1136\/bcr.06.2009.1950","article-title":"Idiopathic congenital chylothorax treated with octreotide","volume":"2010","author":"Sousa","year":"2010","journal-title":"BMJ Case Rep"},{"key":"2021121007542412000_B24","doi-asserted-by":"crossref","first-page":"240473","DOI":"10.1155\/2014\/240473","article-title":"Chylous ascites: evaluation and management","volume":"2014","author":"Al-Busafi","year":"2014","journal-title":"ISRN Hepatol"},{"issue":"976","key":"2021121007542412000_B25","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1259\/bjr\/64849421","article-title":"The effectiveness of lymphangiography as a treatment method for various chyle leakages","volume":"82","author":"Matsumoto","year":"2009","journal-title":"Br J Radiol"},{"key":"2021121007542412000_B26","first-page":"53","article-title":"Congenital chylothorax: current perspectives and trends","volume":"7","author":"Bagur Krishnamurthy","year":"2017","journal-title":"Res Rep Neonatol"},{"issue":"14","key":"2021121007542412000_B27","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1056\/NEJMc1013217","article-title":"Propranolol for intractable diffuse lymphangiomatosis","volume":"364","author":"Ozeki","year":"2011","journal-title":"N Engl J Med"},{"issue":"2","key":"2021121007542412000_B28","first-page":"155","article-title":"Propranolol for the treatment of lymphatic malformations in a neonate - a case report and review of literature","volume":"25","author":"Liviskie","year":"2020","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"4","key":"2021121007542412000_B29","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1002\/ccr3.1449","article-title":"Successful management of extremely high-output refractory congenital chylothorax with chemical pleurodesis using 4% povidone-iodine and propranolol: a case report","volume":"6","author":"Borcyk","year":"2018","journal-title":"Clin Case Rep"},{"issue":"1","key":"2021121007542412000_B30","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1620\/tjem.229.61","article-title":"Propranolol as an alternative treatment option for pediatric lymphatic malformation","volume":"229","author":"Ozeki","year":"2013","journal-title":"Tohoku J Exp Med"},{"issue":"2","key":"2021121007542412000_B31","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2012-2087","article-title":"Treatment of congenital generalized lymphangiectasia with propranolol in a preterm infant","volume":"133","author":"Poralla","year":"2014","journal-title":"Pediatrics"},{"issue":"11","key":"2021121007542412000_B32","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1038\/modpathol.2012.108","article-title":"\u03b2-Adrenergic receptor expression in vascular tumors","volume":"25","author":"Chisholm","year":"2012","journal-title":"Mod Pathol"},{"issue":"2","key":"2021121007542412000_B33","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/j.1365-2133.2010.09848.x","article-title":"Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action","volume":"163","author":"Storch","year":"2010","journal-title":"Br J Dermatol"},{"issue":"1","key":"2021121007542412000_B34","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1038\/s41598-017-01321-2","article-title":"Safety and tolerance of propranolol in neonates with severe infantile hemangiomas: a prospective study","volume":"7","author":"Ji","year":"2017","journal-title":"Sci Rep"},{"issue":"1","key":"2021121007542412000_B35","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1542\/peds.2012-1691","article-title":"Initiation and use of propranolol for infantile hemangioma: report of a consensus conference","volume":"131","author":"Drolet","year":"2013","journal-title":"Pediatrics"},{"issue":"5","key":"2021121007542412000_B36","doi-asserted-by":"crossref","first-page":"e27592","DOI":"10.1002\/pbc.27592","article-title":"Propranolol treatment for chylothorax due to diffuse lymphangiomatosis","volume":"66","author":"Hangul","year":"2019","journal-title":"Pediatr Blood Cancer"},{"issue":"3","key":"2021121007542412000_B37","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/j.1525-1470.2012.01864.x","article-title":"Lack of effect of propranolol in the treatment of lymphangioma in two children","volume":"30","author":"Maruani","year":"2013","journal-title":"Pediatr Dermatol"},{"issue":"3","key":"2021121007542412000_B38","doi-asserted-by":"crossref","first-page":"e20154545","DOI":"10.1542\/peds.2015-4545","article-title":"Initial experience with propranolol treatment of lymphatic anomalies: a case series","volume":"138","author":"Wu","year":"2016","journal-title":"Pediatrics"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-049699\/1182435\/peds_2020049699.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-049699\/1182435\/peds_2020049699.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T19:35:37Z","timestamp":1639164937000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/148\/1\/e2020049699\/179946\/Use-of-Propranolol-in-the-Treatment-of-Chylous"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,7,1]]},"published-print":{"date-parts":[[2021,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2020-049699","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,1]]},"article-number":"e2020049699"}}